Medicare Plans in Arizona

Coverage and Benefits for Medicare Plans Arizona

Any Arizona resident who is 65 or older can apply for enrollment in the federal Medicare program. This program provides Medicare plans in Arizona to retirement age citizens who need additional health care coverage. It is also sometimes referred to as “Traditional Medicare” or “Original Medicare”. The program has two basic parts to it: Medicare Part A, and Medicare Part B. The entire plan is pretty comprehensive; Part A covers most hospital visits, whereas Part B covers your outpatient needs. However, Traditional Medicare still has holes in its coverage plan which you will have to pay for if you don’t have any other form of health care coverage. This article will help you figure out additional coverage options to cover these healthcare “gaps”.

If you have at least 10 years of employment history (or 40 quarters), Medicare Part A is free to enroll. But if your employment history is shorter than the required minimum, you will be required to pay a premium. On top of that, part B will have premium costs associated with it regardless of how long you’ve been employed. For more information, you should contact your local Social Security Office.

Medicare Part A (Hospital Coverage)

Inpatient care in hospitals

Skilled nursing facility care

Hospice care

Home health care

Medicare Part B (Medical Insurance)

Services from doctors and health providers

Outpatient care

Home health care

Durable medical equipment

Some preventive services

Medicare Part C (Medicare Advantage)

Includes all benefits and services covered under Part A and Part B

Usually includes Medicare prescription drug coverage (Part D) as part of the plan

Run by Medicare-approved private insurance companies

May include extra benefits and services for an extra cost

Medicare Part D (Drug Coverage)

Helps cover the cost of prescription drugs

Run by Medicare-approved private insurance companies

May help lower your prescription drug costs and help protect against higher costs in the future

Arizona Medicare Insurance Programs

There are nearly a million people in Arizona currently enjoying Medicare benefits (977,447). 38% of them, an estimated total of 371,430 people are getting their Medicare through Medicare Part C, otherwise known as a Medicare Advantage program. 16.6% are instead choosing to complement their Original Medicare with a Medigap policy. The other 45.4% of Arizona’s elderly might be supplementing their Medicare with a private plan, and employer’s benefits, or with absolutely no additional coverage at all. The latter is an extremely risky option, especially for anyone on a fixed income who cannot easily handle surprise medical bills.

Before going forward, make sure you are currently receiving Medicare benefits. You need to be successfully enrolled in the federal Medicare program in order to qualify for Arizona medicare supplemental insurance.

Why do People Who Live in Arizona Need Additional Coverage beyond Traditional Medicare?

To be clear, the additional coverage is not mandatory. It exists for your piece of mind, and to protect you financially from out-of-pocket expenses which often pop up from relying on Original Medicare alone to cover your health care needs. Below are some of the coverage gaps and their associated costs. If you aren’t careful, you could end up paying full price for:

Medicare Part A Costs

Medicare Part B Costs

$1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services

There are several different supplemental health plans out there that you can choose from. Below, we’re going to go into more detail about the most popular two: Medigap insurance, and Medicare Advantage. It’s up to you to compare the two and figure out which is better for your personal situation.

Option 1: An Arizona Medicare Supplement Plan

These are also known as “Medigap policies” for short. MEdigap policies are specifically tailored to cover the gaps in Traditional Medicare – hence the “gap” part of “Medigap”. The federal government has endorsed 10 different Medigap plans: A, B, C, D, F, G, K, L, M, and N. Plans E, H, and I are no longer available as of 2010. They were phased out due to the Medicare Modernization Act. Every single Medigap plan offers the exact same benefits across all 50 states. But, based on your area, they will differ by cost and by insurance company. Below is a comprehensive comparison list of all 10 plans:

Plans

A

B

C

D

F

G

K

L

M

N

Part A Hospital Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Hospital Reserve Days

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Benefit For Blood

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Part B Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

*Co-Pays

Hospice Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Skilled Nursing Facility

✖

✖

✓

✓

✓

✓

50%

75%

✓

✓

Part A Deductible

✖

✓

✓

✓

✓

✓

50%

75%

50%

✓

Part B Deductible

✖

✖

✓

✖

✓

✖

✖

✖

✖

✖

Part B Excess Charges

✖

✖

✖

✖

✓

✓

✖

✖

✖

✖

Foreign Travel Benefit

✖

✖

✓

✓

✓

✓

✖

✓

✓

✓

Preventive Care Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Out of Pocket Limit

None

None

None

None

None

None

$4,620

$2,310

None

None

Co-Pays are $20 per office visit, and $50 per ER visit if not admitted to a hospital.** A checkmark indicates 100% coverage for the specified benefit.

Option 2: An Arizona Medicare Advantage Plan

Medicare Advantage (Medicare Part C) is another Medicare supplement option which is fairly popular. But if you abandon Original Medicare for a Medicare Advantage (MA) plan, your health care will no longer be managed by the US government. A private insurance company will take over. However, you will still have at least the same benefits that Traditional Medicare offers, because your provider is legally required to offer the same deal that you would have access to on the federal level. Some MA plans offer additional benefits as well.

Some of these benefits could include prescription drug plans, vision, or dental (or a combination of benefits). Many MA beneficiaries prefer Part C for the convenience, even though it is highly likely that your plan will force you to enter a very restrictive network. The doctors you are used to seeing might not be available to you after you switch. This is a very important factor to keep in mind when making important decisions about your health care needs.

Medicare Advantage plans use exclusive Health Maintenance Organizations and Preferred Provider Organizations to give you efficient, affordable care. Here are some HMOs and PPOs near you:

This easy-to-read table helps compare and contrast Medigap and Medicare more effectively:

Questions

Medicare Advantage

Medicare Supplement

How are the plans funded?

Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.

Your monthly premium takes care of the majority of your expenses.

Do I continue paying for Part B?

Yes

Yes

What does it cost me?

Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.

While each plan does require a monthly premium, many of them are affordably priced.

What does the plan cover?

Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.

All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.

Can I budget my health care expenses?

It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.

Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.

Can my plan be cancelled?

Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.

No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.

Are pre-approvals or pre-certifications required?

Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.

No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.

Can I use any doctor or hospital?

Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.

Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.

Can drug, vision, or dental coverage be included in the policy?

Yes.

No. These forms of coverage must be purchased separately.

Who is this plan type generally best suited for?

If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.

If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Additional Arizona Resources and Information

It’s perfectly natural to still have questions regarding AZ Medigap and Medicare Advantage. For this reason, we’ve included a handy directory of contact information you can use to learn more. It’s important to be as well-informed as possible when making such important decisions.

Important Medicare Terms for Arizona

HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.

PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.

Co-Pay: Amount of money charged per visit to doctor, specialist, etc.

Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.

Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.